10 hard skills or competencies (industry competencies) for Claims Examiner II
Skill definition-Applying knowledge of the insurance industry to provide risk management services and protection to various individuals from financial loss.
Level 1 Behaviors
(General Familiarity)
Explains the policy conditions of various insurance contracts and products.
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Level 2 Behaviors
(Light Experience)
Provides prompt responses to clients’ insurance-related questions and concerns.
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Level 3 Behaviors
(Moderate Experience)
Utilizes various tools and technologies to optimize insurance claims turnaround cycles.
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Level 4 Behaviors
(Extensive Experience)
Provides recommendations for improving methods and procedures to enhance insurance claims handling.
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Level 5 Behaviors
(Mastery)
Leads the deployment of strategic approaches to address complex insurance risk management programs.
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Skill definition-Creating, executing, and adhering to state and federal laws governing insurance operations to ensure financial security and consumer protection.
Level 1 Behaviors
(General Familiarity)
Describes the importance of compliance programs in maintaining an insurance legal and regulatory environment.
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Level 2 Behaviors
(Light Experience)
Documents compliance complaints to track and escalate possible legal violations and ensure prompt resolution.
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Level 3 Behaviors
(Moderate Experience)
Executes market conduct exams to verify the adherence of insurance operations to laws and regulations.
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Level 4 Behaviors
(Extensive Experience)
Reviews root causes of regulatory deficiencies to create corrective action plans and ensure adherence.
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Level 5 Behaviors
(Mastery)
Develops an insurance regulatory framework to promote consumers' protection and achieve policy objectives.
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9 soft skills or competencies (core competencies) for Claims Examiner II
Skill definition-Accumulating necessary information from various resources to clarify the situation or make an informed business decision.
Level 1 Behaviors
(General Familiarity)
Explains the use of surveys and interviews in gathering the necessary information.
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Level 2 Behaviors
(Light Experience)
Conducts basic research to identify current industry trends and best practices.
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Level 3 Behaviors
(Moderate Experience)
Participates in various company events to gain information about current business operations.
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Level 4 Behaviors
(Extensive Experience)
Provides training to others about new techniques and strategies for effective data collection.
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Level 5 Behaviors
(Mastery)
Develops best practices and programs to improve data collection across our business.
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Skill definition-A set of written instructions that describes the step-by-step activities to complete tasks in compliance with business standards and industry regulations.
Level 1 Behaviors
(General Familiarity)
Discusses the considerations and concerns on applying SOP for the first time.
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Level 2 Behaviors
(Light Experience)
Gathers information on workflows and business controlling points.
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Level 3 Behaviors
(Moderate Experience)
Initiates SOP revisions to support continuous improvement of processes.
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Level 4 Behaviors
(Extensive Experience)
Evaluates the benefits and drawbacks of a specific SOP; oversees the corresponding enhancements.
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Level 5 Behaviors
(Mastery)
Establishes formal policies and procedures to guide the our SOP practices.
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Summary of Claims Examiner II skills and competencies
There are 10 hard skills for Claims Examiner II, Insurance Industry, Insurance Legal and Regulatory Environment, Insurance Products, etc.
0 general skills for Claims Examiner II.
9 soft skills for Claims Examiner II, Gathering Information, Standard Operating Procedures (SOP), Attention to Detail, etc.
While the list totals 19 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Claims Examiner II, he or she needs to be proficient in Gathering Information, be proficient in Standard Operating Procedures (SOP), and be proficient in Attention to Detail.